Improving process or transforming outcomes?

Public service ‘improvement’ strategies are, in reality, very often measured by organisations’ success in delivering a process, not how lives improve for individuals and their communities. Dr. Peter Dudley FRSA argues that it is third sector organisations that are leading the way in taking a different approach.

“‘It hurts when I do this.” “Then, perhaps, you should stop doing it.“ Parents will recognise some or other variant of this most frustrating of conversations and, no doubt, will have given some or other form of the same reply. Having heard it countless times before, my 16 year-old certainly gave a wry smile as she proofread this piece. So why is it that we tolerate a similar attitude in the management of our organisations and (in particular it seems) when it comes to our institutions of state?

In any civilised society there are three main areas that should be of prime concern to the established state: health, education and civil security. The managed provision of services in these areas forms not only a necessary basis for wealth creation but also, and in the most fundamental sense, any claim to legitimacy.

The difficulty with such fundamental provision – especially when it is free at the point of consumption – is that the drivers of adaptive change can become divided. What constitutes a successful hospital/school/prison can look very different to the consuming patient/pupil/prisoner than it does to those who are responsible for its funding. And so, the notion of ‘improvement’ must be open to interpretation.

There are many examples but a few will suffice: hospital trusts who, despite often paying for expensive advice, seem to believe that the way to improve acute health services is at the expense of patients’ wellbeing.

For example the case of the Mid Staffordshire NHS Foundation Trust, where the Healthcare Commission found that “the care and assessment of patients fell well below acceptable standards” and that senior doctors were “disillusioned” as their concerns about the impact of “the lack of staff in A & E [and] the £10 million cost savings” were not heeded.

Or schools that prioritise educational dogma over student achievement. Despite major changes in education over the years, a House of Commons Public Accounts Committee report published in 2009 states that 16 percent of the adult population lacked literacy skills and 21 percent lacked numeracy skills at: “levels [that] represent the best approximation to what counts as functional competence for everyday living”.

Or a criminal justice system that seem to have been designed more to ensure a steady supply of prisoners, rather than make any real attempt at rehabilitation or the reduction of crime. Sentencing policies seem to ignore evidence of what works and actively promote re-offending. Our policy approach has resulted in a comparatively high (compared to other European countries) and growing prison population, without much evidence that we are succeeding in resettlement. So, even before we calculate the cost of re-offending, the government looks set to continue to spend the £3.5 billion or so a year that this costs.

Broadly speaking, all organisations depend upon the ability to create or provide social value. Even the grand institutions mentioned above – however varied and diffuse their formal or legal structures may be – depend for their survival on the ability to convert whatever social value they create or provide into internal organisational value. Therefore, when social values in their field changes, so too, if they are to survive, must their ability to create organisational value from its provision.

Over the last 30 years the mechanism for reform favoured by governments has been the ‘grand initiative’; the National Curriculum in relation to schools, NHS Foundation Trusts and short-sharp-shock sentencing and the privatisation of prisons. All of these changes are underpinned by the underlying narrative of managerialism, focused on process efficiency and performance, and the propensity to ‘sweat’ the capital asset. This creates at least three problems.

First, although it would be naive to deny that any of these service areas have a significant capital element, this is secondary. The primary asset is human. Sweating the facilitating (capital) asset requires sweating the human asset, which will lead to system failure.

Second, a managerialist attitude to process tends to lead to a narrow focus on performance metrics, initially as proxies for whole system performance but, eventually, as outcomes in their own right.

Third, the notion of improvement is subject to interpretation and will be defined in relation to the core model. As the consuming constituency is diffuse, this will tend to be defined by senior managers and their political masters who are incentivised, either financially or by political expediency, to optimise the processes for which they have performance metrics. All of which means that process optimisation will be prioritised over outcome attainment.

Processes can be endlessly altered in response to emerging changes in social values but the inability to manage the whole organisation towards the achievement of its (primary) purpose will be compromised.

As Geoffrey Vickers, a pioneer in the field of systems practice, said: “The nature of the trap is a function of the nature of the trapped.” This focus on the process of delivery (and its efficiency) to the exclusion of its effectiveness – the extent to which it achieves its purpose – is the trap. Politicians, civil servants and managers become stuck in a mentality where only incremental local ‘improvements’ are possible, and even then only at the expense of causing wider problems. They are, in short, condemned to getting better at doing the wrong thing.

These are difficult and worrying times, which bring challenges that require a great deal of personal, institutional and political will. The third sector (especially) is taking up these challenges: not least, the RSA, which continues to make major contributions: in the fields of drug recovery, education (where the organisation has moved into direct delivery) and the field of prisons, offender management and rehabilitation (where the RSA has set out a new vision of institution). New social enterprises, special interest charitable organisations and, in many cases, individuals are making a difference.

In Liverpool for example, Fusion21 has (amongst others) an established job creation program, the success of which is measured in terms of the permanent jobs they create. It isn’t rocket science but it does give strong clarity of purpose, and a firm basis for assessing the effectiveness of their work processes.

However, it is not so much the program as their attitude that is important. By recognising that activity is subservient to outcome, and embedding the structures to support this, any organisation can become more adaptive, more able to learn about itself and its environment and, therefore, more able to make changes that are outcome focused. In this way internal value always follows the social value created, and the organisation will stay both relevant and successful. And so, if it still hurts, perhaps you should (be thinking about how to) do something else.

Peter Dudley is an independent consultant and academic working in the field of organisational performance. He is a Visiting Fellow of Manchester Business School and currently working in the area of Third Sector involvement in the Industries in Prison initiative.